Stressors associated with the COVID-19 pandemic, disability, and mental health: Considerations from the Intermountain West.

The deleterious mental health effects associated with the COVID-19 pandemic are increasingly apparent, however, questions remain about the extent to which pandemic-related stressor exposure has contributed to increased psychological distress among an already disadvantaged group, individuals with disabilities. The first aim of the study was to examine the distribution of pandemic-related stressors across multiple dimensions-employment, personal and family finances, personal relationships, and quality of social life-among individuals with and without disabilities. The second aim of the study was to examine the association between a composite COVID-19 stressor score and two mental health outcomes-depressive and anxiety symptoms-among the two subsamples. The study used quota-based online survey data (N = 2043) collected in the summer of 2020 from adults (18 and older) residing in the Intermountain West, half of whom had a self-reported disability. Study results demonstrated that individuals with disabilities experienced pandemic-related stressors at significantly higher rates relative to their non-disabled counterparts. Further, pandemic stressor exposure was associated with greater negative effects on their psychological well-being. We argue that the COVID-19 pandemic is generating a secondary mental illness pandemic, and that individuals with disabilities are affected by it at significantly higher proportions.

The link between food insecurity and psychological distress: The role of stress exposure and coping resources.

This study examines the association between food insecurity and mental health over a 3-year period. It also assesses the salience of life stressors and psychosocial coping resources for this association. We utilize data from a two-wave community survey of Miami-Dade County, Florida residents (N = 1488). Findings from SEM analysis reveal that greater food insecurity at W1 is associated with greater depressive symptoms at W2, lending credence to characterizations of food insecurity as a chronic stressor. This association is partly mediated by variation over the study period in social support and mastery. However, no significant mediating effects are observed for the social stress indicators assessed. Food insecurity is associated with diminished psychosocial coping resources, which leads to greater psychological distress. We discuss how these findings extend a stress and coping model of food insecurity, and implications for research and practice.

Disability, Discrimination, and Mental Health during the COVID-19 Pandemic: A Stress Process Model.

Drawing on data from a community survey with a sizeable subsample of people with physical, intellectual, and psychological disabilities in the Intermountain West region of the United States (N = 2,043), this investigation examined the association of social stressors stemming from the COVID-19 pandemic with ableism or disability-related discrimination. We further assessed the significance of these associations for variation by disability status in psychological well-being with a moderated mediation analysis. Study findings provide clear evidence that greater pandemic-related stressor exposure was associated with greater discrimination, which in turn increased the psychologically distressing aspects of the pandemic for people with disabilities relative to people without disabilities. This set of findings challenges us to think about how we engage in research concerning ableism and the proliferation of macro-level stressors such as those associated with the COVID-19 pandemic. The findings also support the application of a minority stress model in addressing mental health contingencies among people with disabilities-in this case, in examining the pandemic's psychological impact.

Race/ethnicity, gender and the SES gradient in BMI: The diminishing returns of SES for racial/ethnic minorities.

Using the 2013-2016 data from the National Health and Nutrition Examination Survey (NHANES), this study uses the case of obesity to examine whether and to what extent racial and ethnic minorities experience fewer benefits from higher SES relative to their white counterparts. Study results provide support for the diminishing returns in health hypothesis and add an intersectional dimension to this perspective by uncovering stark gendered racial/ethnic disparities in BMI. Specifically, research findings demonstrate that higher income and education is associated with lower BMI among white but not black or Mexican American adults. The most substantial decrease in BMI associated with increase in individual-level SES was observed among white women. Taken together, empirical evidence from this study underscores difficulty in overcoming adverse health effects of lower ascribed status (i.e. gender or race/ethnicity) even with attainment of higher achieved social status (i.e. educational attainment or income) and offers promising avenues for future research on identifying complex hierarchies that shape population health outcomes.

Does context matter? A multilevel analysis of neighborhood disadvantage and children's sleep health.

OBJECTIVES: To determine how demographic, socioeconomic, and neighborhood characteristics are associated with bedtimes among US kindergarteners. DESIGN: Parents reported bedtimes of their children as well as personal, household, and residential characteristics via interviews in the Early Childhood Longitudinal Study-Kindergarten (ECLS-K) Class of 1998-1999. The ECLS-K links individual households to US Census tracts. SETTING: A random selection of 1,280 schools and surrounding communities in the US. PARTICIPANTS: A random selection of 16,936 kindergarteners and their parents. MEASUREMENTS: The 2 outcomes were regular and latest weekday bedtimes of kindergarteners. Through a series of nested multilevel regression models, these outcomes were regressed on individual- and neighborhood-level variables, including race/ethnicity, sex, family type, household income, mother's educational attainment, neighborhood disorder, and several additional neighborhood characteristics. RESULTS: Models showed significant (P < .05) bedtime disparities by race/ethnicity, sex, family income, and mother's educational attainment. Additionally, models tended to indicate that kindergarteners from disadvantaged neighborhoods experienced later bedtimes than children from more advantaged areas. Neighborhood characteristics accounted for a portion of racial/ethnic differences, suggesting that bedtime disparities are partly rooted in disparate environmental conditions. CONCLUSIONS: Reducing disparities in childhood sleep may require programs that target not only children and their parents, but also the communities in which they reside.

Gender differences in the association between functional limitation and depressive symptoms: the salience of food insecurity.

The present study evaluated gender differences in the associations of functional limitation with food insecurity and depressive symptoms. Using data from 3,624 respondents ages 18to 80 years from two pooled cross-sectional cycles (2011-2012 and 2013-2014) of the National Health and Nutrition Examination Survey (NHANES), a structural equation model was estimated to assess gender differences in the association between physical limitation and food insecurity, and whether indicators of economic resources mediated an observed interaction. Results demonstrate that food insecurity accounted for about one-tenthof the association between functional limitation and depressive symptoms. Furthermore, these associations were more pronounced among women and were not explained by variation in economic resources. Food insecurity thus appears to be an indicator of psychological adversity among people with functional limitations, especially women, independent of other indicators of economic resources and hardship. Health promotion and social programs should address food insecurity as a unique dimension of adversity in efforts to improve health and well-being.

"Going the Extra Mile": Disclosure, Accommodation, and Stigma Management among Working Women with Disabilities.

Although research has quantitatively evaluated the impacts of stigma on working women with disabilities (WWD), nuanced, qualitative accounts voiced by these women are rare. To address this literature gap, we conducted seven focus groups with forty-two WWD. We asked: "What are women's experiences of disability disclosure and accommodation in the workplace?" Findings reveal that WWD face intentional and unintentional structural discrimination and must weigh the pros and cons of disclosure and navigate devaluation threats in pursuing workplace accommodations. "Going the extra mile" emerged as a stigma management technique that was prevalent among women of higher social capital.

The medicalization of sleeplessness: Results of U.S. office visit outcomes, 2008-2015.

Previous analysis of U.S. physician office visits (1993-2007) indicated that the medicalization of sleeplessness was on the rise and had potentially negative implications for population health. Our study asks if the medicalization of sleeplessness at the level of patient-physician interaction has persisted over time. Using the most recent years available (2008-2015) of the National Ambulatory Medical Care Survey we calculated nationally representative estimates for four sleeplessness-related outcomes of physician office visits: sleeplessness complaint, insomnia diagnosis, and prescription of benzodiazepine and non-benzodiazepine sedative-hypnotics (NBSH). To test for the significance of the linear trajectory, we ran a series of bivariate linear models. We tested three hypotheses grounded in the medicalization framework: if the medicalization of sleeplessness at the interactional level is continuing at a rate comparable to previous analyses, sleeplessness-related outcomes will continue to increase significantly over time (Hypothesis 1); NBSH prescriptions and insomnia diagnoses will continue to outpace sleeplessness complaints (Hypothesis 2); and insomnia diagnoses and use of sedative-hypnotics will increase or remain concentrated among age groups who lack the changing sleep patterns and commonly occurring comorbidities associated with older age (Hypothesis 3). Support for these hypotheses was mixed. Unlike previous analyses wherein all sleeplessness-related outcome trends were positive and statistically significant over time, regression analyses revealed a significant negative NBSH prescription trend 2008-2015 (slope, b = -699,628, P < 0.05). No other associations were significant. Younger age groups were most likely to receive an insomnia diagnosis and NBSH prescription. These trends imply that the medicalization of sleeplessness at the level of patient-physician interaction may be on the decline. We suggest that increasingly negative portrayals of sedative-hypnotics, conservative practice recommendations, and decreased direct-to-consumer advertising for NBSH may decrease consumerism and physician compliance related to the medicalization of sleeplessness. We conclude with a discussion on non-pharmaceutical methods of reducing sleeplessness relevant to population health.

For Better or Worse: an Assessment of the 'Linked Lives' Concept and the Race-Based Effects of Partner Stress on Self-Rated Health Among Older Adults.

OBJECTIVE: The purpose of this study was to assess the utility of the life course framework concept of "linked lives" for examining the effects of partner stress on self-rated health among older adult populations. METHOD: Data were derived from a partner-dyad study of Miami-Dade County residents and their significant others. We limited our analysis to respondents ages 60 or older (n = 409). RESULTS: Regression analyses revealed that greater levels of personally experienced major life events were associated with worse self-rated health. However, the association between a significant other's stress exposure and one's own self-rated health was only statistically significant among Black respondents. DISCUSSION: Extending prior study indicating that Black Americans tend to have worse self-rated health later in life relative to other racial groups, these findings demonstrate the utility of the linked lives concept for furthering an understanding of racial disparities in health based upon loved ones' stressful experiences.

The Incomplete Medicalization of Obesity: Physician Office Visits, Diagnoses, and Treatments, 1996-2014.

OBJECTIVES: Despite increased awareness of obesity-related health risks and myriad treatment options, obesity still affects more than one-third of persons in the United States and is a substantial public health problem. Studies show that physicians play a key role in obesity prevention and treatment. The objective of this study was to examine the extent to which obesity is diagnosed and treated at the level of patient-physician interaction. METHODS: We used data from the National Ambulatory Medical Care Survey (NAMCS), a nationally representative data set of US physician office visits. We estimated the number of obesity diagnoses and prescriptions of weight-loss management solutions (exercise counseling, diet counseling, or weight-loss drugs) in clinical practice from 1996 through 2014. We also calculated rates of obesity diagnosis and compared these rates with national rates of obesity based on body mass index data from the Behavioral Risk Factor Surveillance System (BRFSS) for the same period. RESULTS: The estimated number of weight gain-related physician office visits increased from 2.3 million in 1996 to a peak of 7.6 million in 2012, and then fell to 4.5 million in 2014. National estimates of obesity diagnoses resulting from physician office visits ranged from 7.1 million in 1996 to 12.7 million in 2014 and substantially outnumbered the estimates for weight gain-related physician office visits throughout the study period. Estimates of exercise counseling and diet counseling and weight-loss medication prescriptions resulting from physician office visits fluctuated over time but never exceeded obesity diagnoses. When compared with national rates of obesity from the BRFSS, rates of obesity diagnoses resulting from physician office visits were substantially lower in the NAMCS (17%-30% vs 1%). National trends for weight-loss medication prescriptions closely mirrored those of weight gain-related physician office visits, even though fluctuations were substantial. CONCLUSIONS: Our results suggest that obesity is largely underdiagnosed and undertreated in clinical encounters. Future studies should investigate the structural changes needed to better engage physicians in obesity prevention and care. Practitioners should also reflect on their biases in treating obesity as a chronic disease.

Contributions of personality to social influence: Contingent associations between social network body size composition and BMI.

Social influence is a key determinant of health behaviors and outcomes. Research in the social network tradition emphasizes social structural mechanisms like network content (i.e., the degree to which particular attitudes, attributes, or behaviors are present in the network) and social proximity (i.e., opportunities for social interaction). In contrast, psychologists are oriented toward the individual, identifying how personality traits like self-monitoring affect susceptibility to peer pressure. Here, we integrate social network and personality approaches, examining social influence on body size using surveys of 379 adults with dependent children. Our findings suggest that the association between social network body size composition and respondent BMI is contingent on both individual susceptibility to influence (i.e., high self-monitoring) and social proximity (i.e., opportunities for co-eating). These results indicate that individuals embedded in social networks bring unique sets of social skills and orientations to interactions, potentially influencing the flow of content across networks.

Correlates of Injection Drug Use Among Rural Appalachian Women.

BACKGROUND: Limited research has focused on correlates of injection drug use (IDU) among high-risk subgroups of drug users, particularly women, who may be at increased risk for transmission of infectious diseases such as HIV and Hepatitis C. The purpose of this study is to better understand the contextual and health correlates of IDU among women living in rural Appalachia by examining (1) differences between injectors and noninjectors, and (2) the unique correlates of recent IDU and past IDU. METHODS: This study involved random selection, screening, and face-to-face interviews with 400 rural Appalachian women from jails in one state. Analyses included descriptive statistics, multinomial logistic regression, and stepwise regression to identify significant correlates of recent IDU and past IDU compared to never injecting. RESULTS: Findings indicated that 75.3% of this randomly selected sample reported lifetime injection of drugs. Contextual factors including drug use severity (RRR = 8.66, P < .001), more male sex partners (RRR = 1.01, P < .05), and having injecting partners (RRR = 7.60, P < .001) were robust correlates of recent injection practices. CONCLUSIONS: This study makes an important contribution to understanding factors associated with IDU among rural Appalachian women drug users, which are strongly associated with both relational and health factors. Study findings on the specific factors associated with IDU risk have important implications for tailoring and targeting interventions that should include a focus on the relationship context reducing high-risk injection practices.

Drug Use and Incarceration among Rural Appalachian Women: Findings From a Jail Sample.

BACKGROUND/OBJECTIVE: The purpose of this paper is to examine drug use and incarceration history among rural Appalachian women. METHODS: This study involved random selection, screening, and interviews with rural women from local jails in Appalachia. RESULTS: Of the women randomly selected and screened, 97% met criteria for substance use intervention. Significant factors associated with incarceration history included age, education, custody status, and mental health. A significant interaction was observed between male sex partners and drug use on incarceration history. CONCLUSIONS: Study findings suggest that the drug/crime relationship among rural Appalachian women is associated with their high-risk home environment, partner relationships, and mental health. Specifically, in addition to drug use, factors such as family and child relationships, anxiety, victimization, and relationships with partners should also be considered in the trajectory of criminal careers among rural Appalachian women.

Body weight, perceived weight stigma and mental health among women at the intersection of race/ethnicity and socioeconomic status: insights from the modified labelling approach.

With increasing rates of obesity in the United States, attention to life chances and psychological consequences associated with weight stigma and weight-based discrimination has also intensified. While research has demonstrated the negative effects of weight-based discrimination on mental health, little is known about whether different social groups are disproportionately vulnerable to these experiences. Drawing on the modified labelling theory, the focus of this paper is to investigate the psychological correlates of body weight and self-perceived weight-based discrimination among American women at the intersection of race/ethnicity and socioeconomic status (SES). Analyses use data from the National Health Measurement Study (NHMS), a national multi-stage probability sample of non-institutional, English-speaking adults, ages 35 to 89 in 2005-2006. Our findings demonstrate that the effect of weight-based discrimination on psychological well-being is highly contingent on social status. Specifically, the psychological consequences of discrimination on Hispanic women and women in the lowest household income group is significantly greater relative to White women and women with higher household income, controlling for obesity status and self-rated health. These results suggest that higher social status has a buffering effect of weight stigma on psychological well-being.

Community to clinic navigation to improve diabetes outcomes.

Rural residents experience rates of Type 2 Diabetes Mellitus (T2DM) that are considerably higher than their urban or suburban counterparts. Two primary modifiable factors, self-management and formal clinical management, have potential to greatly improve diabetes outcomes. "Community to Clinic Navigation to Improve Diabetes Outcomes," is the first known randomized clinical trial pilot study to test a hybrid model of diabetes self-management education plus clinical navigation among rural residents with T2DM. Forty-one adults with T2DM were recruited from two federally qualified health centers in rural Appalachia from November 2014-January 2015. Community health workers provided navigation, including helping participants understand and implement a diabetes self-management program through six group sessions and, if needed, providing assistance in obtaining clinic visits (contacting providers' offices for appointments, making reminder calls, and facilitating transportation and dependent care). Pre and post-test data were collected on T2DM self-management, physical measures, demographics, psychosocial factors, and feasibility (cost, retention, and satisfaction). Although lacking statistical significance, some outcomes indicate trends in positive directions, including diet, foot care, glucose monitoring, and physical health, including decreased HbA1c and triglyceride levels. Process evaluations revealed high levels of satisfaction and feasibility. Due to the limited intervention dose, modest program expenditures (~$29,950), and a severely affected population most of whom had never received diabetes education, outcomes were not as robust as anticipated. Given high rates of satisfaction and retention, this culturally appropriate small group intervention holds promise for hard to reach rural populations. Modifications should include expanded recruitment venues, sample size, intervention dosage and longer term assessment.

Partner Influence in Diet and Exercise Behaviors: Testing Behavior Modeling, Social Control, and Normative Body Size.

Previous research has documented social contagion in obesity and related health behaviors, but less is known about the social processes underlying these patterns. Focusing on married or cohabitating couples, we simultaneously explore three potential social mechanisms influencing obesity: normative body size, social control, and behavior modeling. We analyze the association between partner characteristics and the obesity-related health behaviors of focal respondents, comparing the effects of partners' body type, partners' attempts to manage respondents' eating behaviors, and partners' own health behaviors on respondents' health behaviors (physical activity, fruit and vegetable consumption, and fast food consumption). Data on 215 partners are extracted from a larger study of social mechanisms of obesity in family and community contexts conducted in 2011 in the United States. Negative binomial regression models indicate that partner behavior is significantly related to respondent behavior (p < .001), net of controls. These results are suggestive of a behavior modeling mechanism in obesity-related patterns of consumption and physical activity. In contrast, we find little support for the influence of normative body size or partner social control in this sample, though generalizations about the relevance of these processes may be inappropriate. These results underscore the importance of policies and interventions that target dyads and social groups, suggesting that adoption of exercise or diet modifications in one individual is likely to spread to others, creating a social environment characterized by mutual reinforcement of healthy behavior.

Domestic violence in India: insights from the 2005-2006 national family health survey.

This article assesses the prevalence and risk factors of domestic violence in India. The study uses the 2005-2006 India National Family Health Survey-III (NFHS-III) and focuses on the 69,484 ever-married women ages 15 to 49 from all regions, who were administered the domestic violence module. The results show that 31% of respondents experienced physical violence in the past 12 months before the survey; the corresponding figure for sexual violence was 8.3%. The multivariate logistic regression results show key determinants of physical and sexual violence. Some of the most salient findings are that urban residence, household wealth, affiliation with Christian religious denominations, wife's age at marriage and education are associated with lower risk of physical and sexual violence. In contrast, being employed and being the wife of a man who drank alcohol increased the odds of experiencing both physical and sexual violence. Moreover, respondents who believed that wife-beating was justified under certain circumstances were more likely to experience domestic violence. These results and significant regional differences observed in this study suggest that gender role conditioning and cultural norms both contribute to domestic violence. Interventions, therefore, need to go beyond the institutional and legal levels to include cultural capital, which addresses partner and relationship issues.